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Strabismus

Strabismus is defined as a misalignment of the eyes. Strabismus also called as squint.
Orthophoria – Implies as perfect ocular alignment without efforts.
Strabismus consists of two subgroups.
1.Hetrotropia – this is a manifest squint.
Esotropia – deviation of eye  towards inside.
Exotropia -- deviation of eye  towards towards outside.
Hypertropia-- deviation of eye   towards upside.
2.Hetrophoria—this is a latent ocular deviation. Eye alignment is maintained with fusional effort.
Esophoria – inward deviation of eye when fusion is disrupted.
Exophoria-- outward deviation of eye when fusion is disrupted.
Hyperphoria-- upward deviation of eye when fusion is disrupted.
Incyclophoria-- Intortional movement of eye when fusion is disrupted.
Excyclophoria-- Extortional movement of eye when fusion is disrupted.

Concomitant Strabismus
Esotropia
Exotropia
Non Comitantant Strabismus ( Paralytic)
Third Nerve Palsy
Forth Nerve Palsy
Sixth Nerve Palsy
Non Comitantant Strabismus ( Restrictive)
Duane’s Retraction Syndrome
Brown Syndrome
Double Elevator Palsy
Infantile Esotropia
A Pattern Deviations
V Pattern Deviations

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Esotrpoia With A Patterns
If esotropia is atleast 10 prism diopter more  in up gaze ( 25 degree up) than the down gaze (35 degree) then it called as A pattern esotropia.

Causes of A -pattern strabismus

  • Superior oblique muscle over action
  • Relative under action of the Inferior oblique muscles
     

 

Exotrpoia With A Patterns
If exotropia is at least 20 prism diopter more  in down gaze ( 25 degree down) than the up gaze (25 degree up) then it called as A pattern exotropia.

Causes of A -pattern strabismus

  • Superior oblique muscle over action
  • Relative under action of the Inferior oblique muscles
     

 

Management Of  A-Pattern Strabismus

Surgical treatment of Exotropia with A -pattern strabismus with Superior oblique muscle overaction
  • Lateral rectus muscle recessions with superior  oblique muscle weakening
  • Lateral rectus muscle recession with Medial rectus resection with superior oblique muscle weakening

 

Surgical treatment of Exotropia with A-pattern strabismus without superior oblique muscle overaction
  1. Bilateral lateral rectus muscle recessions with down shift
  2. Lateral rectus muscle recessions with down shift + medial rectus muscle resections with up shift

Bilateral lateral rectus muscle recessions with down shift

Lateral rectus muscle recessions with down shift + medial rectus muscle resections with up shift

 
Surgical treatment of Esotropia with A-pattern strabismus with superior oblique muscle over action
  • Medial rectus muscle recessions with superior  oblique muscle weakening
  • Medial rectus muscle recession with lateral rectus resection with superior  oblique muscle weakening
Surgical treatment of Esotropia with A-pattern strabismus without oblique muscle overaction
  1. Bilateral medial rectus muscle recessions with up shift
  2. Medial  rectus muscle recessions with up shift + lateral rectus muscle resections with down shift

Bilateral medial rectus muscle recessions with up shift

 

Medial  rectus muscle recessions with up shift + lateral rectus muscle resections with down shift

Download Patient Case Sheet Performa In Word Format

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References

 

Download Free Trial Version Of Strabismus Software "SquintMaster Software"

Strabismus or Squint Software called SquintMaster

Salient Features Of SquintMaster Software

Designed and Developed By Dr Sudhir Singh ,M.S

  • Suggests diagnosis and sub type of deviations
  • Important tool for patient counseling
  • Suggests surgical options
  • Creates simulated image of deviations
  • With help of squint simulator and calculator user can calculate surgical dose ( Amount of surgery)
  • AC /A Simulator And Calculator
  • A V Patterns Simulator And Calculator
  • Parks 3 Step Test
  • Knapp's Classification
  • Simulator for ductions, versions and grades of oblique muscles over action
  • Classification and management of Duane's Retraction Syndrome
  • Management of third nerve palsy
  • Management of forth nerve palsy
  • Management of sixth nerve palsy
  • Management of Browns Syndrome
  • Management of double elevator palsy

 

 

 

 

 

 

 

 

 

 

 

 

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